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Baur et al. Mini-invasive Surg 2021;5:27 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2021.28

Technical Note Open Access

Management of hernial orifices in robotic inguinal

hernia repair

Johannes Baur, Michaela Ramser, Ulrich A. Dietz
Department of Visceral, Vascular and Thoracic Surgery, Kantonsspital Olten, Olten 4600, Switzerland.

Correspondence to: Dr. Johannes Baur, Department of Visceral, Vascular and Thoracic Surgery, Kantonssppital Olten, Baslerstr.
150, Olten 4600, Switzerland. E-mail: johannes.baur@spital.so.ch

How to cite this article: Baur J, Ramser M, Dietz UA. Management of hernial orifices in robotic inguinal hernia repair. Mini-
invasive Surg 2021;5:27. https://dx.doi.org/10.20517/2574-1225.2021.28

Received: 26 Feb 2021 First Decision: 35 Mar 2021 Revised: 1 Apr 2021 Accepted: 13 Apr 2021 Available online: 6 Jun 2021

Academic Editor: William W. Hope Copy Editor: Yue-Yue Zhang Production Editor: Yue-Yue Zhang

Abstract
The development of a postoperative seroma after endoscopic transabdominal (TAPP) or extraperitoneal (TEP)
groin repair is a frequent problem. Although seromas are usually only mildly symptomatic, the swelling that
develops postoperatively often causes patients to feel insecure and worried. In the literature some technical
approaches to reduce the incidence of postoperative seroma are described. This technical note deals with the
authors’ approach in the management of large medial and lateral hernial orifices during robotic r-TAPP procedures
using DaVinci Xi technology with the aim of seroma prophylaxis.

Keywords: Inguinal hernia, robotic surgery, hernial orifices, seroma, barbed suture, TISSEEL, fibrin sealant

INTRODUCTION
The postoperative occurrence of seroma is a challenge after inguinal hernia repair and often leads to
insecurity and concern of patients, who may misinterpret the postoperative swelling as an early hernia
recurrence, a finding also known as pseudo-recurrence. In some cases, the seroma can also affect the nerves
of the groin region and lead to increased postoperative pain or even the development of a chronic pain
syndrome . Despite the usual spontaneous remission of seromas in the course of a few weeks, it is
[1]
reasonable to find strategies to reduce the risk of postoperative seroma formation. The reported incidence of
[2]
postoperative seroma varies between 0.5%-12.2% .

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
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